Dialysis Access Cases by Alexander S. Yevzlin Arif Asif Robert R. Redfield III & Gerald A. Beathard

Author:Alexander S. Yevzlin, Arif Asif , Robert R. Redfield III & Gerald A. Beathard
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Fig. 27.2 Angioplasty of stenotic zone

Fig. 27.3Post-angioplasty angiogram . A Previously stenotic zone

Fig. 27.4 Tunneled catheter in place

The catheter functioned well when tested using a 10 mL syringe. The patient was sent to the dialysis facility where dialysis was performed without difficulty.

Discussion

Stenosis of the internal jugular vein among today’s dialysis population is not an unusual finding. The challenge is in finding a site suitable for catheter insertion when the need arises. In this case, a problem with the vein was suspected at the time it was evaluated with ultrasound because of failure of the vein to dilate significantly with a Valsalva maneuver. In these cases, if the vein can be cannulated it is worthwhile to do so in order to completely evaluate the anatomy. Some of these are salvageable as was the case in this patient. If it is possible to pass a guidewire, an angioplasty balloon can be used to treat the stenosis. In this case, cannulation of the vein at the optimal catheter insertion site was possible since the problem was lower down. Once this area had been dilated, insertion of the catheter was easily accomplished.

In a case such as this, removal of the catheter at a later date may be followed by a loss of the access site since the process of sclerosis was already far advanced at the time of placement and will very likely progress. In a patient who is totally catheter dependent, this loss would be very problematic. In such a case, a plan for continued dialysis access should be made in advance. Such a patient might be an excellent candidate for a HeRO device as long as the venous access is available.

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